Separation

How do I begin to write? How do I, a mid-thirties white male physician who is happily married to the love of my life, begin to write about a 20-year-old Native American woman, incarcerated as a bystander to a violent crime, who gave birth 40 hours ago and must now give up her baby?

The first thing to say is how very little I know about this woman.

I don’t know the story of her family, other than that there is a history of substance abuse. I don’t know the details of her own birth, whether there was alcohol involved in her mother’s pregnancy, if she was born early, if she was breastfed. I don’t know if she was wanted or loved or ignored or abused or some of all of these things.

Our electronic medical record could be called comically inadequate, except in this case the inadequacies are anything but amusing. Her chart lacks a Y/N checkmark beside “Less than 8th grade education”, and the checks for “Alcohol” (N), “Drugs” (Y) and “Tobacco” (N) are the opposite of what she has told me—she admits to alcohol and tobacco around the time of and possibly after getting pregnant, but denies drug use. There are negative checks next to “Abusive relationship” and “Cats” (cat feces being a risk for a parasite called Toxoplasmosis, although in developed countries a more common source of this infection is from consumption of undercooked or cured meat or meat products).

There are affirmative checks next to “No family support,” “Poor living environment,” and “Significant social problems.”

What I can speak to is what woman has been through. When I assumed her care late in the second half of her pregnancy, she had just had preterm contractions and been told that she was a bad mother to the fetus for not taking a medicine that was making her sick and for which there is no evidence of improved outcomes. For every clinic visit, she would be escorted into the exam room shackled at the ankles and wrists. Not one but two generously-proportioned guards would stand outside while we talked. For her delivery, she was allowed to have no family or other support present.

To their credit, all of the wardens and nursing staff always treated her kindly and courteously.

At our first visit this young woman was very guarded. As the number of visits increased both in number and frequency—she had several more scares for early labor—she seemed to open up little by little. Occasionally she even smiled. Whether she grew to look forward to our prenatal visits, I’ll never know.

Because of horror stories she’d heard about epidurals, she wanted to “go naturally” when it came time, without medicine in her spinal fluid to numb her pain. LL and I had just watched The Business of Being Born and I supported her decision; at the same time I did my best to dispel the myths regarding epidurals.

2 days after she’d made it to term, having had several previous visits to the hospital for which she was “ruled out” for labor, her bag of water broke and her cervix began the often-tortuous dilation to 10 centimeters. She stuck with her decision to not have an epidural. Throughout the labor she remained quiet, stoic, and polite. Every time I came in to talk with her she asked appropriate questions. Mostly she would be looking down with her face a blank slate, but on rare occasions she would let a smile escape, and even more rarely let her pain show. As I would be walking out of the room, she would invariably look up and quietly say, “Thank you for everything.”

17 hours, several bags of Pitocin, 5 doses of GBS-prophylaxis antibiotics, a last-minute epidural, internal monitoring, and 20 minutes of pushing later, she delivered a 5 pound 7 ounce beautiful crying baby girl.

For the next precious 40 hours she got to hold her baby. The baby was more consistent with being 2 weeks early than being term, and had difficulty latching onto her breast to feed. But it did not become febrile, lose more than the accepted 10% of its weight, or become jaundiced. Somehow through all that this woman had endured her baby was healthy. And in her eyes, for this baby, was something I had not seen. It was love. It was pure and simple love.

I again find it difficult to write. For me it was hard but easy this morning, when she had to go back to jail and her baby had to go to a grandmother somewhere to be taken care of: I am there, I cry with her, I leave. I carry on with my life. I cannot know, cannot imagine, what this woman went through. Is going through. Right now everything is up in the air. If all goes well for her in court, she and her baby could be re-united as early as the end of next week. If not it could be months, or years.

Ojala that it goes well. Ojala that it goes well.